Provider Demographics
NPI:1750483095
Name:HARRIS, GEORGE SWIFT (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SWIFT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858
Mailing Address - Country:US
Mailing Address - Phone:906-864-2320
Mailing Address - Fax:906-864-2298
Practice Address - Street 1:2012 10TH ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858
Practice Address - Country:US
Practice Address - Phone:906-864-2320
Practice Address - Fax:906-864-2298
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010094161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33588100Medicaid
MI4029562Medicaid